Needs Assessment Survey for Parents

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Boys & Girls Club is planning to apply for a 21st Century Community Learning Center grant to support an after school program for students. Your responses to this survey will help us better understand student and family needs as we plan the after school program.

Does your child need help completing homework after school?

Yes

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If yes, who usually helps your child with his/her homework?

Myself/Parent

Sibling

Teacher

No one

Other:

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Would it be helpful to you to have more information about what your child is learning at school?

Yes

Clear selection

Does your child currently participate in any activities after school?

Yes

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If yes, how often does he/she participate?

4-5 times/week

2-3 times/week

1 time/week

A few times/month

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IF your child does not participate in activities after school, please indicate the reason(s) why:

No activities available

Available activities don't interest him/her

Activities are too expensive

Lack of transportation

He/she takes care of family member(s) after school

Other:

Please indicate the time(s) that your child/children would be likely to attend an afterschool program:

After school

On school holidays

During summer vacation

If your child/children attend an afterschool program will they need transportation home?

Yes- I'd need the program to provide transportation home for my child/children.

No- I'd be able to pick up my child/children when the afterschool program is over.

Clear selection

Has your child ever witnessed, or been subject to, bullying at his/her school?

Yes

I don't know

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How important are the following student services/activities for an afterschool program?

Homework Help

Very Important

Somewhat important

Not important

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Tutoring

Very Important

Somewhat important

Not important

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Reading enrichment

Very Important

Somewhat important

Not important

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Writing enrichment

Very Important

Somewhat important

Not important

Clear selection

Math & Science enrichment

Very Important

Somewhat important

Not important

Clear selection

Arts & Music

Very Important

Somewhat important

Not important

Clear selection

Nutrition education

Very Important

Somewhat important

Not important

Clear selection

Sports & Fitness Activities

Very Important

Somewhat important

Not important

Clear selection

Drug & Violence Prevention

Very Important

Somewhat important

Not important

Clear selection

Anger Management/Positive Thinking

Very Important

Somewhat important

Not important

Clear selection

Community Service Projects

Very Important

Somewhat important

Not important

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College Readiness

Very Important

Somewhat important

Not important

Clear selection

Career & Workforce Readiness

Very Important

Somewhat important

Not important

Clear selection

Please indicate which parent activities/services your family members may be interested in attending:

Family Activity Nights

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Parenting Classes

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

College Applications/Financial Aid Info

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Adult Ed- Technology

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Adult Ed- Resumes

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Adult Ed- Literacy

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Adult Ed- English as a Second Language

Definitely Attend

Likely Attend

Not Likely to Attend

Clear selection

Check any barriers that you think might prevent your family from participating in parent activities/services:

Lack of childcare

Lack of transportation

Activities not interesting or engaging

Other:

Please provide any ideas you have for community partners or services that could be a part of the 21st Century Community Learning Center afterschool program:

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